Sleep Apnoea, Poor Sleep and ED

1. 1Testosterone suppression. The overnight testosterone surge depends on consolidated deep sleep. Apnoea fragments sleep hundreds of times a night, and the surge never properly happens.
2. 2Intermittent hypoxia. Repeated dips in oxygen saturation cause oxidative stress and endothelial damage — the same mechanism as smoking or diabetes, delivered nightly.
3. 3Sympathetic overdrive. Each apnoeic event triggers a surge of adrenaline. Chronic sympathetic activation raises blood pressure and directly opposes the parasympathetic state an erection requires.
4. 4Daytime fatigue. Exhaustion reduces libido and the willingness to initiate sex, independent of any physiological effect.

• ✓Loud, habitual snoring — often the thing a partner complains about first.
• ✓Witnessed pauses in breathing, or gasping and choking awakenings.
• ✓Waking unrefreshed despite adequate hours in bed.
• ✓Daytime sleepiness, especially while driving or in meetings.
• ✓Morning headaches.
• ✓Neck circumference over about 17 inches.
• ✓High blood pressure that is difficult to control.

Several of these together justify asking for a sleep study. Home sleep apnoea testing has made this far less onerous than it used to be — for most people it is a device worn for one night at home.

CPAP remains the standard treatment for moderate to severe obstructive sleep apnoea. Several studies have found improvement in erectile function with consistent use, and improvements in testosterone in some cohorts. The consistent theme is that benefit tracks with adherence — men who tolerate the mask do better.

• CPAP — most effective, but adherence is the limiting factor. Persist through the first few weeks and get the mask fit adjusted rather than abandoning it.
• Mandibular advancement devices — a reasonable alternative in mild to moderate apnoea or for CPAP-intolerant patients.
• Weight loss — can substantially reduce severity and sometimes resolves mild apnoea.
• Positional therapy — for apnoea that occurs mainly when sleeping on the back.
• Avoiding alcohol and sedatives before bed — both relax the upper airway and worsen events.